Friday, December 30, 2005

We continue to debate how to deal with those who have shown themselves to be dangerous and mentally ill. To some extent the Americans with Disabilities Act is leading us to changing our conception of mental illness. In this case it is argued that Mr. Josephs was not mentally ill and therefore not dangerous after treatment. Through the nineteenth and twentieth centuries we held that once a person had an illness they always had it, and presumably the risk associated with it stuck to them. But looking back to colonial times in the U. S. A. people were often locked up when they seemed dangerous, but when the episode passed (obviouslly without effective medication) they were allowed to resume their usual roles in society. As I recall this was true for James Otis one of the signers of the constitution.

He was a man who stuck to his guns if not to his wives. He always seemed to me to be evidence of how one's own experience, mixed with bias, in psychoanalysis can lead to views that resist all forms of public changes in opinion. While most went along with what they knew was a political (and I would say wise) decision about homosexuality by the profession, Socarides knew what he saw through his particular lens on the world.I wonder how many other psychoanalysts in less controversial and public areas also feel that they have seen a truth that the profession denies.

Saturday, December 17, 2005

In this op-ed piece Brandon Krupp, the psychiatrist who resigned over the state of Rhode Island's attempt to extend the incarceration of a sexual offender by placing him in a civil unit of the state hospital, argues forcefully that this is a dangerous misuse of psychiatric hospitals. Historically the inability of psychiatrists to control admissions to state hospitals has been a major factor in the deterioration of care in these facilities. In the nineteenth century, the elderly, poor and homeless were often warehoused in these facilities under the pretense that they were receiving care. Now it appears that we are in the midst of seeing state hospitals used to extend criminal incarceration, under the pretense that care is being provided.

Monday, December 05, 2005

In this intruiging article about the first face transplant I was particularly struck by the following:"Brain-dead patients in France are presumed to be organ donors unless they have made explicit provisions to the contrary, and approval by next of kin is not normally required. But given the delicacy of the case, the donor's family was consulted about the possible harvesting of part of the donor's face during the initial interviews that are undertaken to ensure that the deceased had not given instructions preventing organ donations."If ever there was an un-American law, this must be it. It certainly demonstrates how cultural and political practices shape what we regard as every day ethical practices.